Provider Demographics
NPI:1619288966
Name:FOX VALLEY PHYSICAL THERAPY AND WELLNESS,LLC
Entity Type:Organization
Organization Name:FOX VALLEY PHYSICAL THERAPY AND WELLNESS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-208-6433
Mailing Address - Street 1:2011 DEAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-4802
Mailing Address - Country:US
Mailing Address - Phone:630-549-0511
Mailing Address - Fax:630-549-0512
Practice Address - Street 1:2011 DEAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-4802
Practice Address - Country:US
Practice Address - Phone:630-549-0511
Practice Address - Fax:630-549-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty